Prevalence of Type 1 Diabetes-Related Autoantibodies in Adults With Celiac Disease
Results from a population-based survey
5
0
Laboratory of Pediatrics and Neurology, University Medical Center Nijmegen, the Netherlands. MD, Division of General Internal Medicine, Medisch Spectrum Twente
,
P.O. Box 50000, 7500 KA En- schede
,
The Netherlands
1
De- partment of General Internal Medicine, University Medical Center Nijmegen, the Netherlands; and the
2
Department of Endocrinology, University Medical Center Nijmegen
,
the Netherlands; the
3
Department of Laboratory Medicine, Mie Uni- versity School of Medicine
,
Mie
,
Japan.
Third Department of Internal Medicine, Mie Univer- sity School of Medicine
,
2-174 Edobashi, Tsu, Mie 514-8507
,
Japan
4
Third Department of Internal Medicine, Mie University School of Medicine
,
Mie
,
Japan; and the
5
From the Department of Economics, Moore School of Business, University of South Carolina
,
Colum- bia, South Carolina. PhD
,
Department of Economics, Moore School of Business, University of South Carolina
,
Columbia, SC 29208
6
Department of Internal Medicine, Univer- sity Medical Center
,
Utrecht, the Netherlands. Haeften, MD
,
Department of Internal Medicine
,
G 02.228
,
University Medical Center
,
P.O. Box 85500, 3508 GA Utrecht
,
The Netherlands
7
Department of Biomedical Genetics, Uni- versity Medical Center
,
Utrecht
,
the Netherlands
-
O agnostic proficiency of the World
ur objective was to evaluate the
diHealth Organization (WHO) and
the National Cholesterol Education
Program (NCEP)-III definitions (1,2) for the
metabolic syndrome in a Mexican
nationwide, population-based survey. Details of
the sampling procedures have been
previously described (3). The population was
composed of 2,158 men and women aged
20 69 years sampled after a 9- to 12-h
fasting period. For the WHO criteria,
insulin resistance was diagnosed if a
nondiabetic case had fasting insulin
concentrations 126 pmol/l (21 U/ml) (75th
percentile in Mexican adults). The
ageadjusted prevalence was 13.61% for the
WHO criteria (n 268) and 26.6% for
the NCEP-III definition (n 574). After
excluding patients with diabetes, the
prevalence was 9.2 and 21.4%, respectively.
The agreement between the definitions
was assessed in 1,969 subjects; 189 cases
were eliminated due to the lack of a urine
sample.
The number of abnormal cases was
lower using the WHO criteria. Only 237
of the 545 subjects (43.4%) who fulfilled
the NCEP criteria were diagnosed as
affected using the WHO definition. Just 16
of 253 cases (6.3%) detected by the WHO
definition did not fulfill the NCEP
definition. The agreement between the criteria
was moderate ( 0.507). On the other
hand, the subjects diagnosed using the
WHO recommendations had a worse
profile than the cases detected by the
NCEP-III definition onlythey had a
higher BMI and higher non-HDL
cholesterol, triglyceride, and glucose
concentrations. The demonstration of insulin
resistance among the nondiabetic
population caused the lack of agreement in 202
of the 242 cases that fulfilled the NCEP
definition but failed the WHO criteria.
Other reasons for disparity were the
higher thresholds used by the WHO
criteria; these differences explained the lack
of agreement in 66 of the 152 cases with
diabetes.
In conclusion, the prevalence of the
metabolic syndrome is influenced by the
selection of the diagnostic criteria. The
WHO criteria identified a lower number
of cases than the NCEP-III definition.
These differences were explained mainly
by the inclusion of abnormally high
insulin concentrations as a diagnostic
criterion. However, the presence of insulin
resistance may help to identify patients
more severely affected (4).
CARLOS A. AGUILAR-SALINAS, MD1
ROSALBA ROJAS, PHD2
FRANCISCO J. GO MEZ-PEREZ, MD1
VICTORIA VALLES, MD1
JUAN MANUEL ROS-TORRES, MD1
AURORA FRANCO, PHD2
GUSTAVO OLAIZ, PHD2
JUAN A. RULL, MD1
JAIME SEPULVEDA, PHD2
From the 1Departamento de Endocrinologa y
Metabolismo del Instituto Nacional de Ciencias
Medicas y Nutricio n Salvador Zubiran, Mexico City,
Mexico; and the 2Instituto Nacional de Salud P
ublica, Cuernavaca, Morelos, Mexico.
Address correspondence to Carlos Alberto
Aguilar-Salinas, MD, Vasco de Quiroga 15, Mexico City
14000, Mexico. E-mail: .
2003 by the American Diabetes Association.
References
1. Expert Panel on Detection, Evaluation,
and Treatment of High Blood Cholesterol
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Third Report of The National Cholesterol
Education Program (NCEP) Expert Panel
on Detection, Evaluation, and Treatment
of High Blood Cholesterol In Adults
(Adult Treatment Panel III). JAMA 285:
2486 2497, 2001
2. Alberti FGMM, Zimmet PZ: Definition,
diagnosis and classification of diabetes
mellitus and its complications. Part 1:
diagnosis and classification of diabetes
mellitus provisional report of a WHO
consultation. Diabet Med 15:539 553, 1998
3. Aguilar-Salinas CA, Rojas R, G omez-Perez
FJ, Garca E, Valles V, Ros-Torres JM,
Franco A, Olaiz G, Sepu lveda J, Rull JA:
Prevalence and characteristics of
earlyonse (...truncated)